Healthcare Provider Details

I. General information

NPI: 1922054758
Provider Name (Legal Business Name): JOHN W. BRENEMAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/25/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

405 PHOENIX DR UNIT A
CHAMBERSBURG PA
17201-4534
US

IV. Provider business mailing address

PO BOX 584
SHIPPENSBURG PA
17257-0584
US

V. Phone/Fax

Practice location:
  • Phone: 717-263-4999
  • Fax: 717-263-5522
Mailing address:
  • Phone: 717-263-4999
  • Fax: 717-263-5522

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberMD010487E
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: